Division of Cardiology, Department of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada.
Curr Opin Cardiol. 2012 Mar;27(2):130-6. doi: 10.1097/HCO.0b013e3283502137.
Death and hospitalization for acutely decompensated heart failure are predominantly due to volume overload, have increased in the past 10 years, carry poor outcomes, and are costly to the healthcare system. Clinical monitoring with daily weight and symptoms is relatively insensitive for early detection of volume overload. This lack of diagnostic accuracy has led to the development of technologies as an aid for early detection of clinical decompensation.
Multidisciplinary heart failure clinics are currently the standard of care; however, recent large randomized studies have failed to show benefits in comparison to usual care when follow-up is frequent. Technologies, such as intrathoracic impedance monitoring incorporated into implantable cardioverter defibrillators (ICDs) and cardiac resynchronization therapy (CRT) devices, have shown variable sensitivity and low positive predictive value in predicting heart failure hospitalizations. As such, they have yet to consistently show efficacy in reducing hospitalizations for heart failure. Implantable hemodynamic monitoring devices have shown promise in reducing hospitalization rates for acutely decompensated heart failure, over and above heart failure clinic care. However, these studies were performed on younger populations with relatively few noncardiac comorbidities and have not been studied in the typical elderly heart failure patient populations.
The ability to acquire hemodynamic data with the help of implanted devices can provide early warning of heart failure decompensation and thus may aid in preventing hospitalizations for heart failure. Further studies will clarify patient populations most likely to benefit from this intervention.
急性失代偿性心力衰竭导致的死亡和住院主要是由于容量超负荷引起的，在过去 10 年中有所增加，预后不良，且给医疗保健系统带来了巨大的经济负担。通过日常体重和症状进行临床监测对于早期发现容量超负荷相对不敏感。这种诊断准确性的缺乏导致了技术的发展，作为早期发现临床失代偿的辅助手段。
多学科心力衰竭诊所目前是标准的护理方法；然而，最近的大型随机研究表明，与常规护理相比，在随访频繁的情况下，并没有带来益处。技术，如植入式心律转复除颤器（ICD）和心脏再同步治疗（CRT）设备中的胸腔内阻抗监测，在预测心力衰竭住院方面表现出不同的敏感性和低阳性预测值。因此，它们尚未在减少心力衰竭住院方面显示出一致的疗效。植入式血流动力学监测设备在降低急性失代偿性心力衰竭的住院率方面显示出了前景，优于心力衰竭诊所护理。然而，这些研究是在年龄较小、合并症较少的人群中进行的，尚未在典型的老年心力衰竭患者人群中进行研究。
植入设备获取血流动力学数据的能力可以提供心力衰竭失代偿的早期预警，从而可能有助于预防心力衰竭住院。进一步的研究将阐明最有可能从这种干预中获益的患者人群。
